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The Top 10 Concerns of New Parents

Every day parents who bring their babies to our office are spilling over with questions ranging from what to do about diaper rash to how to get their baby to sleep through the night. Experts, not to mention family and friends, sometimes offer contradictory advice. Is it any wonder new moms and dads often feel overwhelmed? Being a new parent is far from easy, as my wife, Martha, and I, parents of eight, can attest. Fortunately, there are almost always ways you can soothe your baby's distress and ease your mind. Here are answers to some of the most common questions new parents ask their pediatricians.

Sleepless nights, SIDS, and spoiling

1. I can't take another sleepless night. What can I do to encourage my baby to sleep?

There is no magic way to get a baby to nod off. But even though you can't dictate when and how much your baby will sleep, you can create conditions that encourage sleep and provide cues that it's time to rest.

Create a bedtime ritual. Settling your child in for the night requires more than just putting him to bed -- babies need routine. Infants who go to bed at a reasonably consistent time each night usually have less trouble falling and staying asleep. If your baby has difficulty winding down, a warm bath or a soothing massage before bedtime may help relax him. With a child younger than 6 months, you can also try wearing him in a sling or carrier as you stroll around the house.

Another way to lull him into slumber is to breastfeed or bottlefeed him until he drifts off. But to prevent tooth decay and ear infections, don't let your infant fall asleep with the bottle in his mouth, and don't leave the bottle in the crib. Fathers can also help induce sleep by positioning the baby's head in the crook of their neck, under the chin. The infant picks up vibrations from Dad's larynx that can be soothing. Once your child is sleeping, you can safely deposit him in bed and creep away.

Try various sleeping arrangements. I've found that the easiest and quickest way to resettle your baby when he wakes at night is to have him sleep in your room. You can move your newborn's crib next to your bed or buy a crib that attaches to the side of your bed. The idea is to comfort your baby before you and he are fully awake.

Look for possible causes of sleep trouble. When your infant wakes up crying, and feeding or changing doesn't comfort him, check for ill-fitting sleepwear, a stuffy nose, a bedroom that's too hot or too cold, or nasal irritants -- such as cigarette smoke, animal dander, or dust. All of these factors can contribute to waking. If eliminating them doesn't help, discuss possible medical causes, such as reflux, food or milk allergies, or ear infections, with his doctor.

Babies eventually learn to soothe themselves to sleep. As your child grows, encourage him to fall asleep on his own by putting him in his crib while he's still awake and staying until he nods off. Once your baby sleeps through the night, try increasing the distance between you and his crib, or put him to sleep in his own room.

2. I'm terrified of losing my baby to SIDS. What can I do to protect him?

Although sudden infant death syndrome (SIDS) is quite rare (it occurs in fewer than 1 out of every 1,000 babies), it ranks at or near the top of every parent's list of worries. Don't let fear of SIDS interfere with your enjoyment of your baby. Most infants are healthy and stay that way. The following measures are effective at reducing SIDS risk:

Provide a healthy womb environment. Premature birth and low birth weight are two risk factors for SIDS. Prematurity may not be preventable, but you can tip the scales in your baby's favor by getting good prenatal care and eating right.

Don't allow smoking around your baby. One of the most significant risk factors for SIDS is exposure to cigarette smoke both before and after birth. Don't smoke or allow others to smoke around you during pregnancy. In addition, studies show that when babies breathe cigarette smoke, their risk of SIDS doubles.

Put your baby to sleep on his back. Since the beginning of the Back to Sleep public-awareness campaign in 1994, which urged parents to put babies to sleep lying on their back, U.S. SIDS rates have declined by nearly 40 percent.

Breastfeed your baby if you can. Research suggests, for reasons that aren't clear yet, that SIDS rates are lower in breastfed babies.

Provide a safe sleeping environment. Avoid putting your baby to sleep on surfaces he can sink into, such as beanbags, soft bedding, or couches. There's been controversy about whether babies who sleep in bed with their parents are at greater risk of SIDS. Although blankets, loose sheets, and pillows are risk factors, I'm convinced that safe sleepsharing (when the child is on his back and the parents don't use alcohol, illegal drugs, or sleeping pills) reduces the risk of SIDS. One common theory is that SIDS results from problems with breathing. I believe that any sleeping arrangement that increases a parent's awareness of changes in a child's breathing, as sleepsharing does, may lower this risk. If you decide to sleepshare, make sure that the mattress is firm and tight against the headboard (I recommend sleeping on a king-size bed if possible), don't use heavy blankets or sheets, and don't place your baby on a pillow or blanket. Dress him lightly and keep him away from the bedding.

3. Will I spoil my baby if I pick her up every time she cries?

It's best not to let your baby cry it out. Crying is her language -- she does it to communicate, not manipulate. In fact, researchers have disproved the theory that holding a baby a lot or responding promptly to her cries makes her clingy and dependent. In one study of mother-infant pairs, some of the mothers responded quickly and lovingly when their babies cried. The others, fearful of spoiling, did not respond as quickly. The researchers found that the infants of the responsive mothers cried less frequently, were less clingy, and seemed more securely attached to their caregivers. The other babies cried and whined more often, were more insecure about separating from their caregivers, and were less comfortable playing on their own.

But that doesn't mean that you need to respond immediately to every squeak. As your baby gets older, your response time can lengthen. When she is 6 months old, you can use reassuring body language and talk to her before scooping her up when she fusses. By delaying, you'll help her learn how to soothe herself.

Healthy babies, using discipline, and working parents

4. My baby often gets sick. How can I keep her healthy?

During the two years before their immune system fully develops, most babies get at least three respiratory illnesses and a couple of diarrhea-inducing intestinal infections. You can lessen the frequency and severity of sickness in the following ways:

Breastfeed your baby as long as possible. Breastfed babies get fewer colds, ear infections, and intestinal bugs. And when breastfed infants do come down with these illnesses, they're less severe.

Keep your baby's nose clear. If your infant's nose is clogged, put unmedicated saline nasal drops in her nostrils and suction them with a nasal aspirator (both are available over the counter in pharmacies). In the winter months, when central heating dries out a baby's respiratory passages, making them more prone to infection, take your infant into the bathroom, run a warm shower, and let her inhale the steam. Or turn on a cool-mist vaporizer in your baby's bedroom at night.

Keep your baby's sleeping environment as clean as possible. Remove dust collectors such as stuffed animals from the nursery (a few are okay, of course), and avoid using products such as paint, aerosols, perfumes, and hair sprays near your baby or her room. Again, don't allow smoking.

If your infant is in daycare, make sure it's a healthy environment. Find out whether the daycare facility accepts children with colds or infections who might pass them on to your child. It's also a good idea to observe whether daycare providers wash their hands after changing diapers, maintain separate diapering and food-serving areas, sanitize toys when necessary, and discourage the sharing of bottles, pacifiers, and other personal items.

Take your baby to your pediatrician for well-baby checkups. During these visits, your doctor will give your child immunizations. Staying on schedule for vaccines is the easiest way to protect your baby's health.

5. When and how should I begin using discipline with my child?

With each interaction between you and your baby, you lay the foundation for discipline. It's by developing the right relationship with your child, rather than using the "right" techniques, that you start the process. To do this, you'll need to establish trust, and then you can provide structure and set limits. Childproof your home so that your baby has a safe place to play and learn. Then set limits by saying no to an exploring infant headed for trouble. When you childproof your home, you remove most of the "no's," so that a "yes" environment prevails and an infrequent "no" really means something. Another way to limit saying no is a discipline trick, "distract and divert." Instead of saying no when your child is headed toward a flower vase, call out his name or the name of an object he likes, such as "ball" or "cat," to redirect his attention.

6. How will I balance parenting and my job when I return to work?

I believe that the main issue is not whether you work outside the home but the quality of attachment you maintain with your baby. It's important that you not let emotional distance develop as a result of your absence. Here are some ways to keep a close bond:

Share the load. When both spouses work, sharing household duties becomes essential so that each parent has one-on-one time with the baby each day.

Ensure a happy departure and a happy reunion. Cuddle and feed your baby before leaving for work and as soon as you come home. Tell your caregiver not to feed her right before you return from work, especially if you are breastfeeding, so that you have that opportunity to bond with your baby.

Make time together attachment time. Wearing your baby in a carrier around the house and when running errands can help you feel closer to her. You'll be surprised how easy it is to incorporate your baby into aspects of your life outside of work.

Find a caregiver who complements your parenting style. When choosing a babysitter, accept that you won't find your clone. Instead, search for a trustworthy person who has the same parenting philosophy you do and who is committed to your baby. Then keep your eyes peeled for signs of a baby-caregiver mismatch, such as a baby who is angry or clingy after an initial adjustment time of a few weeks with a new caregiver or a nanny who's frazzled or irritable at the end of the day. You can also look for signs that your baby is being tended to properly (a quick count of diapers will tell you if she's being changed often enough, for example) or periodically arrive home early or on your lunch break to check on your baby's care.

Helping out, eating well, milestones, and Super-parents

7. How can I get my husband to help more with the baby? I'm burned out!

Since a tired mother is a tired wife, a mom's exhaustion should be an incentive for fathers to help in baby care. But some men don't know how and may need to be taught. Here's how to encourage your partner to do his share:

Show and tell. Choose the baby care tasks you most need help with, and do these activities together with your partner. Point out techniques that work well, but also allow him to discover his own way of doing things. Let him take the lead, not just follow.

Arrange for Dad and baby to be home alone. It can be surprising how well Dad measures up. If your baby is breastfeeding, leave her with a full tummy or a bottle of Mom's pumped milk for Dad to give.

Delay the rescue. When Dad picks up the crying baby, allow the two of them time and space to work it out, instead of immediately stepping in.

8. How can I be sure that my newborn is getting adequate nutrition?

In the first few weeks, it's hard to tell if your baby is getting enough milk, so see your pediatrician often to track weight gain. After the first couple of months, you'll be a pro.

The breastfed infant: By about 1 week of age, a well-nourished breastfed baby will have six to eight wet diapers per day, and three or four with stool. If you feel your baby sucking vigorously, hear her swallowing, feel your milk letting down (this is sometimes accompanied by tingling), and see your baby drifting contentedly off to sleep, chances are she is well nourished.

While it's normal for babies to lose a little weight after birth, weight gain is generally the best indicator that your baby is eating enough. Infants who are well fed will usually put on an average of 4 to 5 ounces a week for the first few weeks, and an average of 1 to 2 pounds per month for the first six months.

The bottle-fed infant: It's a little easier to tell if a bottle-fed baby is well nourished. Many newborns may only take 2 to 3 ounces at each feeding for the first week. But by 1 month of age, most infants are up to 3 to 4 ounces at each feeding. As a general guideline, a formula-fed infant will usually consume an average of 2 to 3 ounces of formula per pound per day. So, if your baby weighs 10 pounds, she may take 20 to 30 ounces per day.

9. My baby doesn't reach his motor milestones as quickly as other infants do. Should I be worried?

Milestones aren't an indication of a baby's intelligence or a badge of good parenting. In fact, the age at which a child reaches a milestone isn't as important as his progression through developmental steps. For instance, most babies move from sitting to pulling themselves up to standing to walking, yet each may reach these milestones at a different age. As long as your infant is progressing and your doctor isn't worried, there's no reason for you to be.

10. How will I know if I'm a good parent?

The key attribute of a good parent is responsiveness. If you are responsive to your baby's cues, even if you sometimes can't figure out what he wants or needs, you're a good enough parent, as long as you care and try.

Perfectionistic feelings often surface in new parents. My advice is to relax and ease up on yourself. Remember, your baby doesn't compare you with other parents. To him, you are the most wonderful person in the whole world -- and that's good enough.

Contributing editor William Sears, M.D., is the author of 30 books on childcare.